Provider Demographics
NPI:1982709390
Name:SILVER LAKE DENTAL PLLC
Entity Type:Organization
Organization Name:SILVER LAKE DENTAL PLLC
Other - Org Name:JAMES S HOUGH DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-762-3027
Mailing Address - Street 1:6176 N GOVERNMENT WAY
Mailing Address - Street 2:
Mailing Address - City:COUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815
Mailing Address - Country:US
Mailing Address - Phone:208-762-3027
Mailing Address - Fax:208-762-0531
Practice Address - Street 1:6176 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:COUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815
Practice Address - Country:US
Practice Address - Phone:208-762-3027
Practice Address - Fax:208-762-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty